Maxillofacial plastic and reconstructive surgery · 2025
Evaluation, prevention, and treatment of inferior alveolar nerve injury in bilateral sagittal split mandibular osteotomy.
СтатьяОбзорНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Zhao Hao-Ran, Zhao Ning, Xu Yao-Xiang, Wang Fu-Chen, Xiao Wen-Lin
Аннотация
BACKGROUND: Bilateral sagittal split osteotomy (BSSO) is a widely adopted surgical procedure for correcting mandibular deformities, yet neurosensory disturbance (NSD) of the inferior alveolar nerve (IAN) remains a significant postoperative complication. This complication adversely impacts patients' quality of life due to persistent sensory abnormalities in the lower lip and chin region.
MAIN BODY: This narrative review summarizes anatomical risks and prevention/management strategies. Cone-beam CT (CBCT) may clarify canal anatomy and support risk stratification. Nerve-sparing osteotomy modifications are intended to limit traction and direct exposure. Fixation choice may influence surrogate and early clinical outcomes; monocortical miniplates (MCF) may be associated with lower radiographic canal penetration and earlier recovery than bicortical screws (BCF), whereas long-term clinical differences are uncertain. Piezoelectric/ultrasonic devices may improve precision and reduce tissue trauma, and virtual planning with 3D-printed guides may support safer osteotomy paths. For established IAN injury, photobiomodulation (PBM) may support earlier recovery; corticosteroid effects are route-dependent-intravenous dexamethasone mainly reduces edema with uncertain NSD benefit, while local betamethasone at closure may yield early improvement.
CONCLUSION: Comprehensive management likely requires integrated preoperative assessment, refined technique, and postoperative adjuncts. Current evidence supports considering multimodal approaches-imaging-guided planning, nerve-sparing modifications, and PBM-to potentially reduce NSD and enhance early recovery, while standardized protocols and larger studies are needed before firm recommendations.
MAIN BODY: This narrative review summarizes anatomical risks and prevention/management strategies. Cone-beam CT (CBCT) may clarify canal anatomy and support risk stratification. Nerve-sparing osteotomy modifications are intended to limit traction and direct exposure. Fixation choice may influence surrogate and early clinical outcomes; monocortical miniplates (MCF) may be associated with lower radiographic canal penetration and earlier recovery than bicortical screws (BCF), whereas long-term clinical differences are uncertain. Piezoelectric/ultrasonic devices may improve precision and reduce tissue trauma, and virtual planning with 3D-printed guides may support safer osteotomy paths. For established IAN injury, photobiomodulation (PBM) may support earlier recovery; corticosteroid effects are route-dependent-intravenous dexamethasone mainly reduces edema with uncertain NSD benefit, while local betamethasone at closure may yield early improvement.
CONCLUSION: Comprehensive management likely requires integrated preoperative assessment, refined technique, and postoperative adjuncts. Current evidence supports considering multimodal approaches-imaging-guided planning, nerve-sparing modifications, and PBM-to potentially reduce NSD and enhance early recovery, while standardized protocols and larger studies are needed before firm recommendations.